Peer visitation (PV) provides individuals dealing with a particular injury an opportunity to interact with a peer who has survived or managed a similar injury. The power of PV is well-explained by social learning theory: through observation of successful role models we increase self-efficacy and learn specific actions and coping strategies. PV has been reported to be beneficial by a range of injured/ill persons, including those with brain injury, cancer, burns, and amputation. Recipients of PV endorse decreased isolation, increased optimism, increased coping ability, and increased knowledge of treatment options and resources as benefits. The Amputee Coalition of America (ACA) has a well-developed nationally-based PV program for amputees. Written PV and PV trainer manuals provide the backbone of the ACA's standardized training and certification system. The ACA's manuals and training model were originally developed for civilians with limb loss, but have been successfully adapted for several other populations, including OIF/OEF service members with amputation at Walter Reed Army Medical Center and caregivers of people with limb loss.
The overall goal of this proposal is to lay a foundation for PV within the VHA by adapting the ACA's established PV written materials for veterans of OIF/OEF polytrauma/blast-related injury and for their caregivers. The written materials form the backbone of a PV program, by providing a standardized means by which to identify, train, educate and evaluate PV trainers and PVs. Once written materials are completed, we can proceed with the implementation of a PV program in the context of an intervention study. Specific Objective # 1: Develop workbooks for OIF/OEF polytrauma veterans and their caregivers to be used in structured PV training. These workbooks will include detailed training exercises (e.g., self-assessments, role playing, practice PV sessions) to complete during the requisite 2-day PV training, as well as background information to enhance the knowledge of the PV and resource materials to copy/distribute to the people they visit once certified as a PV. Specific Objective # 2: Develop Trainer Manuals to accompany PV workbooks. Designed for allied health professionals who will be certified PV trainers of both veterans and caregivers, these manuals will include detailed course outlines and lesson plans for training PVs , background information on adult learning and relevant content areas (e.g., TBI) and guidelines for selecting, evaluating, and certifying PVs (including standardized evaluation forms).
The PI and three additional investigators (two who were the original authors of the ACA training materials) adapted the ACA materials for persons with OIF/OEF combat-related PT/BRI and their caregivers based on a Participatory Action Research (PAR) model. Procedures: A diverse group of OIF/OEF veterans (n=6), caregivers (n=6), and professionals (n=10) with relevant expertise was assembled to serve as an Advisory Panel. Panel members were systematically interviewed to identify areas of importance specific to the intended audience. Based on this input and a background literature review, we revised the materials, and then circulated the draft to panel members for review/approval.
Interviews with panel members indicated several key components of a successful Peer Visitor Program:
(1) the need for program infrastructure and PT/BRI Clinician involvement in selecting and training PVs and providing ongoing programmatic support;
(2) the value of certified PVs becoming official VA Volunteers;
(3) the importance of offering separate veteran and caregiver programs;
(4) matching PVs to recipients by injury type or demographic factor was less important to veterans and caregivers than providers thought it would be;
(5) flexible strategies are needed to train PVs with TBI and/or PTSD and to accommodate caregivers, underscoring the need for local clinical support at each site
The following selection criteria are recommended for Veteran Peer Visitors:
A member or former member of Armed Forces who sustained any combination of injuries related to OIF/OEF training, service, or deployment.
2. Be nominated by a clinician or self-nominated with clinician endorsement.
3. Be medically "stable"
4. Be available for up to 16 hours of training (not necessarily consecutive).
5. Deemed to have sufficient support system in place as indicated by a response of "usually" or "always" to the question "In the past week, how often have you received the social and emotional support you need?" (CDC, 1998).
6. Determine that they are emotionally ready to participate using a self-assessment questionnaire included at the outset of the training experience.
The findings were reviewed and approved by the HS R & D Review Committee on 2/5/2010.
There are multiple "grassroots" peer visitor programs within the VA system. To our knowledge, none have been formally evaluated within a study, nor is there any standardization of selection or training criteria. With the completion of these materials, we are poised to train PV trainers and identify PVs within the VA in the context of a demonstration study, and continue in close collaboration with the QUERI team to ensure that the materials developed in this proposal are efficiently delivered and carefully evaluated.
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